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Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection

Published online by Cambridge University Press:  02 January 2015

Raghu U. Varier ,
Eman Biltaji ,
Kenneth J. Smith ,
Mark S. Roberts ,
M. Kyle Jensen ,
Joanne LaFleur  and
Richard E. Nelson
Raghu U. Varier*
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah NW Pediatric Gastroenterology, LLC, Portland, Oregon
Eman Biltaji
Affiliation:
Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah
Kenneth J. Smith
Affiliation:
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Mark S. Roberts
Affiliation:
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
M. Kyle Jensen
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah
Joanne LaFleur
Affiliation:
Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah
Richard E. Nelson
Affiliation:
Department of Internal Medicine, University of Utah, Salt Lake City, Utah
*
Address correspondence to Raghu U. Varier, DO, MSc, NW Pediatric Gastroenterology, LLC, 300 N. Graham St., Suite 420, Portland, OR (r.u.varier@gmail.com).
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Abstract

OBJECTIVE

Clostridium difficile infection (CDI) places a high burden on the US healthcare system. Recurrent CDI (RCDI) occurs frequently. Recently proposed guidelines from the American College of Gastroenterology (ACG) and the American Gastroenterology Association (AGA) include fecal microbiota transplantation (FMT) as a therapeutic option for RCDI. The purpose of this study was to estimate the cost-effectiveness of FMT compared with vancomycin for the treatment of RCDI in adults, specifically following guidelines proposed by the ACG and AGA.

DESIGN

We constructed a decision-analytic computer simulation using inputs from the published literature to compare the standard approach using tapered vancomycin to FMT for RCDI from the third-party payer perspective. Our effectiveness measure was quality-adjusted life years (QALYs). Because simulated patients were followed for 90 days, discounting was not necessary. One-way and probabilistic sensitivity analyses were performed.

RESULTS

Base-case analysis showed that FMT was less costly ($1,669 vs $3,788) and more effective (0.242 QALYs vs 0.235 QALYs) than vancomycin for RCDI. One-way sensitivity analyses showed that FMT was the dominant strategy (both less expensive and more effective) if cure rates for FMT and vancomycin were ≥70% and <91%, respectively, and if the cost of FMT was <$3,206. Probabilistic sensitivity analysis, varying all parameters simultaneously, showed that FMT was the dominant strategy over 10, 000 second-order Monte Carlo simulations.

CONCLUSIONS

Our results suggest that FMT may be a cost-saving intervention in managing RCDI. Implementation of FMT for RCDI may help decrease the economic burden to the healthcare system.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 4 , April 2015 , pp. 438 - 444
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

This work has been presented at Digestive Disease Week (DDW) 2014, May 3–6. Abstract #1896750 accepted February 11, 2014. Poster Presentation, Sa1282.

References

1. McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409–415.CrossRefGoogle ScholarPubMed
2. Redelings, MD, Sorvillo, F, Mascola, L. Increase in Clostridium difficile–related mortality rates, United States, 1999–2004. Emerg Infect Dis 2007;13:1417–1419.Google Scholar
3. Gravel, D, Miller, M, Simor, A, et al. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009;48:568–576.CrossRefGoogle Scholar
4. Burckhardt, F, Friedrich, A, Beier, D, Eckmanns, T. Clostridium difficile surveillance trends, Saxony, Germany. Emerg Infect Dis 2008;14:691–692.Google Scholar
5. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108:478–498 – quiz 499.Google Scholar
6. O'Horo, JC, Jindai, K, Kunzer, B, Safdar, N. Treatment of recurrent Clostridium difficile infection: a systematic review. Infection 2014;42:43–59.Google Scholar
7. McFarland, LV, Elmer, GW, Surawicz, CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769–1775.Google Scholar
8. Leong, C, Zelenitsky, S. Treatment strategies for recurrent Clostridium difficile infection. Can J Hosp Pharm 2013;66:361–368.Google Scholar
9. Johnson, S. Recurrent Clostridium difficile infection: a review of risk factors, treatments, and outcomes. J Infect 2009;58:403–410.CrossRefGoogle ScholarPubMed
10. Bakken, JS, Borody, T, Brandt, LJ, et al. Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol 2011;9:1044–1049.Google Scholar
11. Kassam, Z, Lee, CH, Yuan, Y, Hunt, RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol 2013;108:500–508.Google Scholar
12. van Nood, E, Vrieze, A, Nieuwdorp, M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile . N Engl J Med 2013;368:407–415.Google Scholar
13. Brandt, LJ. American Journal of Gastroenterology Lecture: Intestinal microbiota and the role of fecal microbiota transplant (FMT) in treatment of C. difficile infection. Am J Gastroenterol 2013;108:177–185.CrossRefGoogle ScholarPubMed
14. Brandt, LJ, Aroniadis, OC, Mellow, M, et al. Long-term follow-up of colonoscopic fecal microbiota transplant for recurrent Clostridium difficile infection. Am J Gastroenterol 2012;107:1079–1087.Google Scholar
15. Agito, MD, Atreja, A, Rizk, MK. Fecal microbiota transplantation for recurrent C. difficile infection: ready for prime time? Cleveland Clin J Med 2013;80:101–108.Google Scholar
16. Brandt, LJ, Aroniadis, OC. An overview of fecal microbiota transplantation: techniques, indications, and outcomes. Gastrointestinal Endoscopy 2013;78:240–249.CrossRefGoogle Scholar
17. Rohlke, F, Stollman, N. Fecal microbiota transplantation in relapsing Clostridium difficile infection. Therap Adv Gastroenterol 2012;5:403–420.CrossRefGoogle ScholarPubMed
18. Guo, B, Harstall, C, Louie, T, Veldhuyzen van Zanten, S, Dieleman, LA. Systematic review: faecal transplantation for the treatment of Clostridium difficile-associated disease. Aliment Pharmacol Ther 2012;35:865–875.Google Scholar
19. Borody, TJ, Campbell, J. Fecal microbiota transplantation. Gastroenterol Clin NA 2012;41:781–803.Google Scholar
20. Konijeti, GG, Sauk, J, Shrime, MG, Gupta, M, Ananthakrishnan, AN. Cost-effectiveness of competing strategies for management of recurrent Clostridium difficile infection: a decision analysis. Clin Infect Dis 2014;58:1507–1514.Google Scholar
21. Bartsch, SM, Curry, SR, Harrison, LH, Lee, BY. The potential economic value of screening hospital admissions for Clostridium difficile . Eur J Clin Microbiol Infect Dis 2012;31:3163–3171.Google Scholar
22. McFarland, LV, Surawicz, CM, Rubin, M, Fekety, R, Elmer, GW, Greenberg, RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 1999;20:43–50.Google Scholar
23. Figueroa, I, Johnson, S, Sambol, SP, Goldstein, EJC, Citron, DM, Gerding, DN. Relapse versus reinfection: recurrent Clostridium difficile infection following treatment with fidaxomicin or vancomycin. Clin Infect Dis 2012;55:S104–S109.Google Scholar
24. Whitlock, EP, Lin, JS, Liles, E, Beil, TL, Fu, R. Screening for colorectal cancer: a targeted, updated systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2008;149:638–658.CrossRefGoogle ScholarPubMed
25. Ko, CW, Dominitz, JA. Complications of colonoscopy: magnitude and management. Gastrointestinal Endosc Clin NA 2010;20:659–671.Google Scholar
26. Consumer Price Index. ftp://ftp.bls.gov/pub/special.requests/cpi/cpiai.txt. Published 2014. Accessed January 14, 2014.Google Scholar
27. Pignone, M, Saha, S, Hoerger, T, Mandelblatt, J. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:96–104.Google Scholar
28. Bartsch, SM, Umscheid, CA, Fishman, N, Lee, BY. Is fidaxomicin worth the cost? An economic analysis. Clin Infect Dis 2013;57:555–561.Google Scholar
29. Stranges, PM, Hutton, DW, Collins, CD. Cost-effectiveness analysis evaluating fidaxomicin versus oral vancomycin for the treatment of Clostridium difficile infection in the United States. Value Health 2013;16:297–304.CrossRefGoogle ScholarPubMed
30. Constantinides, VA, Heriot, A, Remzi, F, et al. Operative strategies for diverticular peritonitis: a decision analysis between primary resection and anastomosis versus Hartmann’s procedures. Ann Surg 2007;245:94–103.Google Scholar
31. Claxton, K, Paulden, M, Gravelle, H, Brouwer, W, Culyer, AJ. Discounting and decision making in the economic evaluation of health-care technologies. Health Econ 2011;20:2–15.Google Scholar
32. Whitehead, SJ, Ali, S. Health outcomes in economic evaluation: the QALY and utilities. Br Med Bull 2010;96:5–21.Google Scholar
33. Weinstein, MC, Torrance, G, McGuire, A. QALYs: the basics. Value Health 2009;12:S5–S9.Google Scholar
34. Physician Fee Schedule Search Results. Centers for Medicare and Medicaid Services website. http://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=3&T=0&HT=0&CT=3&H1=45378&M=5. Published 2010. Accessed January 14, 2014.Google Scholar
35. Kelly, CR, Ihunnah, C, Fischer, M, et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014;109:1065–1071.Google Scholar
36. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
37. Kunimoto, D, Thomson, AB. Recurrent Clostridium difficile-associated colitis responding to cholestyramine. Digestion 1986;33:225–228.CrossRefGoogle ScholarPubMed
38. Yamazaki, S, Nakamura, H, Yamagata, S, et al. Unexpected serum level of vancomycin after oral administration in a patient with severe colitis and renal insufficiency. Int J Clin Pharmacol Ther 2009;47:701–706.Google Scholar
39. Quera, R, Espinoza, R, Estay, C, Rivera, D. Bacteremia as an adverse event of fecal microbiota transplantation in a patient with Crohn’s disease and recurrent Clostridium difficile infection. J Crohns Colitis 2014;8:252–253.Google Scholar
40. De Leon, LM, Watson, JB, Kelly, CR. Transient flare of ulcerative colitis after fecal microbiota transplantation for recurrent Clostridium difficile infection. Clin Gastroenterol Hepatol 2013;11:1036–1038.Google Scholar
41. Solari, PR, Fairchild, PG, Noa, LJ, Wallace, MR. Tempered enthusiasm for fecal transplant. Clin Infect Dis 2014;59:319–319.CrossRefGoogle ScholarPubMed
42. Infectious Diseases Society of America. Fecal transplant pill knocks out recurrent C. diff infection. ScienceDaily, 4 October 2013. www.sciencedaily.com/releases/2013/10/131004105253.htm. Published 2014. Accessed January 27, 2014.Google Scholar
43. Louie, TJ, Miller, MA, Mullane, KM, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–431.Google Scholar